Platelet Rich Plasma (PRP) is becoming a popular treatment for muscle strains, arthritis/cartilage injuries, and tendinopathies, but the evidence behind its’ use is limited. Specifically there is a lack of large human trials with randomization to both placebo injections and alternative treatments. Consistent with alternative treatments PRP’s clinical utilization is outpacing the evidence leaving many more questions than answers. To date there is insufficient research to advocate for injections into injured tendons and in some cases (corticosteroid) authors have argued the risks outweigh the benefits. A recent research article highlights a risk of PRP.

A case report published in the Clinical Journal of Sports Medicine highlights a risk on the utilization of PRP for sports injuries (Redler et al. 2018). Authors describe a single patient with a degenerative patellar tendinopathy treated with a series of 4 PRP injections. Upon subsequent surgical examination authors reported a complete rupture in the patellar tendon with significant degeneration is the surrounding tendon. Although the results of this report must be taken in consideration due to its’ methodology, including a single patient, the authors state this report questions both the effectiveness and safety of using this injection in patients with severe tendinopathy.

Knee arthritis will affect many older adults limiting their ability to participate in their daily, occupational, and recreational activities. Lost independence and function is one of the most common concerns among patients with knee arthritis who are treated in our Boulder Physical Therapy practice. In addition to manual therapy to the involved joints, exercise remains the gold standard of conservative treatment for this condition. Specifically strength training has been shown to both reduce knee pain and improve function and independence among older adults. New research suggests this form of exercise may also prevent progression of arthritis.

Chang and colleagues examined the association between hip abductor strength on both cartilage injury progression and patient function in patients with knee arthritis (Osteoarthritis and Cartilage. 2019). They enrolled 275 knee in 164 patients with knee arthritis. All patients were given baseline strength and functional assessments, as well as, x rays of their knees. Authors reported patients who had greater hip abduction strength at baseline demonstrated reduced progression of their arthritis at 2 year follow up. In addition, these stronger individuals had a reduced risk of disability and an improved functional level at 5 year follow up. Authors reported these findings provide support for the important role of hip strengthening in modifying the disease progression of arthritis.

Patellofemoral Pain Syndrome, pain under the knee cap, is the most common diagnosis of knee pain affecting both sedentary and active individuals. Muscle weakness in the hip and knee are often present in individuals with this diagnosis, but a cause and effect relationship between strength and knee pain has been difficult to established. In short, the research is divided on this relationship especially within the variable of hip weakness. Thus questions remain on which muscle imbalances may predispose an otherwise pain free individual for future patellofemoral pain.

A recent systematic review of the available evidence on the development of patellofemoral pain syndrome reviewed 18 studies of 4818 research participants (Neal et al. Br J Sp Med. 2019). Authors found three common groups of research subjects including military recruits, adolescents, and runners. They reported moderate to strong evidence body mass index, age, and leg alignment were notpredictive of future knee pain. Interestingly, although common in clinical patients, moderate evidence reported hip weakness was not predictive of future knee pain. Authors reported quadricep weakness, especially among military recruits, was associated with future onset of knee pain.

Paracetamol, or acetaminophen, was initially introduced in the late 1800s and has become the most commonly prescribed medication for fever and pain in the United States. It is one class of medications recommended by the American College of Rheumatology for patients with arthritis who have not responded favorably to weight loss and Physical Therapy. Although a relatively inexpensive and commonly prescribed medication recent research has demonstrated the harmful effects of acetaminophen when combined with other pain medications which may also contain the same drug. A recent Cochrane Review of the evidence analyzed acetaminophen’s effects on patients with hip or knee arthritis.

Leopoldino and colleagues reviewed 10 randomized placebo controlled trials of 3541 patients with either hip or knee arthritis (Cochrane Review. 2019). Patients within these trials were followed for up to 24 weeks to determine the impact of the medication on pain, activity, and adverse events. Authors reported at 3 and 12 week follow there was high quality evidence that acetaminophen provided no clinically important improvements in pain and physical function. No increased risk of adverse events was found among the medication vs. placebo patients. Patients with knee or hip arthritis should follow up with their physician before making any medication decisions.

Knee osteoarthritis is a common and increasing diagnosis that is contributing to an rapid rise in total knee arthroplasty surgery in the United States. Knee Osteoarthritis leads to disability in greater than 10% of those over 55 years, however manual therapy and exercise has shown to be twice as successful compared to a home exercise program in short term pain and function. More importantly, research has shown this Physical Therapy approach can postpone or prevent the need for knee replacement. One of most common complaints from patients with knee arthritis is pain with walking or ascending/descending stairs. Weakness of the quadriceps, hip adductors (inner thigh) and abductors (outer hip) are crucial to improving stair climbing and squatting ability.

A recent study (Hislop et al. 2019. Br J Sports Med) aimed to find the benefit of adding hip strengthening exercises to quad strengthening exercises among people with Knee Osteoarthritis. Authors randomized participants with knee arthritis into one of two groups: knee strengthening or knee and hip strengthening. Consistent with clinical practice, the authors found a decrease in patient related pain as well as improvements in patient function in patients who combined hip and knee strengthening exercises compared to knee strengthening exercises alone.

Knee arthritis is a common condition among older adults and remains one of the greatest causes of disability in our country. Consistent with many musculoskeletal conditions there remains a disconnect between imaging findings and a patient’s clinical presentation. Studies have shown many patients without knee pain can have signs of arthritis on their x rays. In addition, many older adults with knee pain can have negative x rays for arthritis. This lack of association is likely due to many patient factors including activity level, functional demands, strength, flexibility, and overall health. For example, a stronger patient is less likely to experience pain during a given activity compared to their weaker peers. Strength training as part of an individually tailored Physical Therapy program remains the gold standard for conservative treatment of this condition. A new research article highlights other modifiable factors which may influence the progression of knee arthritis.

A longitudinal, observational study was conducted to determine the factors associated with knee arthritis progression in older adults (Halilaj et al. Osteoarthritis and Cartilage. 2018). Authors recruited subjects based on presence (N = 3285) of the condition. Patient history, demongraphic, functional outcomes and x findings were taken upon the first visit. Patient’s were then categorized by risk of progression of arthritis. High risk patients included histories of knee pain, aching or stiffness, previous total knee replacement, family history of arthritis, high body mass index, or previous knee injury. Patient disease progression was based on follow up x rays at 1 and 2 year follow up. In addition, patient’s completed functional outcomes at these time points.

Authors then calculated predictive variables which may have contributed to the radiographic findings. Consistent with previous research, x ray findings of arthritis including joint space narrowing did not predict patient symptoms. Authors prediction models found a slower gait speed, poor sleep, and higher meat intake were associated with knee arthritis disease progression. This supports previous research on the importance of a patient’s overall health in managing their knee arthritis. Smoking history, body mass intake, sleep, diet, and exercise remain some of the most powerful modifiable factors to reduce the progression and symptoms associated with knee arthritis.